Geographic variations in end-of-life hospitalisations for patients with mental illness: a population-based observational study in England, UK

Abstract Background High rates of hospital admissions have been reported for patients with mental illness, but less is known about factors associated with multiple hospitalisations at the end-of-life in this group. Aim To describe the geographical variations in end-of-life hospitalisations and examine factors associated with multiple hospitalisations (≥ 2) in the last 90 days of life for people with mental illness. Methods A national population-based observational study in England UK using a linkage of Hospital Episode Statistics Admitted Patient Care (HES-APC) and the Office for National Statistics (ONS) death registry data. Our cohort comprised patients aged 18 and over, who died in England between 2018-04-01 and 2019-03-31 with HES-APC diagnoses of (1) Schizotypal, delusional disorders or schizophrenia, (2) schizoaffective or bipolar affective disorder, (3) substance use disorders; or (4) depressive episodes or recurrent depressive disorders. Geographic variations of end-of-life hospitalisations for each diagnostic group were described across National Health Services (NHS) regions. Modified Poisson regression models were used to estimate factors associated with multiple end-of-life hospitalisations in each diagnostic group. Results A total of 49,775 patients with mental illness died in the year 2018–2019, of whom 50.2% (n = 25,004) had multiple end-of-life hospitalisation in the last 90 days of life. Factors positively associated with multiple end-of-life hospitalisations included older age, being resident in an urban area, cancer related deaths, and, for patients with depressive disorders, higher socioeconomic deprivation. Conclusion Strengthening primary and community care services targeted at older adults with cancer could potentially reduce multiple end-of-life hospitalisations for patients with mental illness.